PIMS in children – Symptoms, diagnosis, treatment

PIMS in children - Symptoms, diagnosis, treatment

PIMS is a paediatric inflammatory multisystem syndrome. It is closely related to COVID-19 (paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2). This means that the condition occurs in children and adolescents after they have been infected with SARS-CoV-2. What are the symptoms of PIMS and what risks does it carry?

What is PIMS in children?

The disease develops as a result of a significant dysregulation of the immune system – usually 2-4 weeks after undergoing SARS-CoV-2 infection. What seems very important, PIMS can develop in children and adolescents who have undergone COVID-19 very mildly or even asymptomatically. Thus, it happens that parents are not even aware of the infection, which is why vigilance is so important. In case of alarming symptoms – we advise you to consult a doctor as soon as possible.

PIMS, also known as pocovid syndrome or MIS-C (multisystem inflammatory syndrome in children), is associated with the risk of developing serious complications and can even lead to death. The disease most commonly affects school-aged children (median age is 9 years) 2-6 weeks after infection.

Read: Vaccination against COVID in young children – what should you know?

PIMS: symptoms in children

Although children and adolescents usually undergo coronavirus infection mildly or asymptomatically, some may develop immune system dysfunction, inflammation within organs, and eventually organ failure.

The most commonly observed symptoms in pediatric polyarthritis are fever, headache, respiratory symptoms (sore throat, cough), gastrointestinal problems, rash, myocardial dysfunction, conjunctivitis, tongue lesions, hypotension and markedly enlarged lymph nodes.

Diagnosis of PIMS – what to look for?

PIMS can be diagnosed on the basis of several basic symptoms, such as:

  • fever above 38.5°C persisting for more than 3 days;
  • elevated markers of ongoing inflammation: ESR (Biernacki’s precipitation), C-reactive protein (CRP> 100 mg / l), ferritin, and clotting factors: D-dimers, fibrinogen, decreased lymphocyte count (lymphopenia is characteristic of COVID-19 infection), hypoalbuminemia.

Associated symptoms are also possible:

  • rash, bilateral nonpurulent conjunctivitis or symptoms of mucositis and dermatitis(mouth, hands or feet);
  • hypotension or shock;
  • gastrointestinal complaints (vomiting, diarrhea, abdominal pain);
  • myocardial dysfunction, pericarditis, valvular or coronary abnormalities;
  • blood clotting disorders (coagulopathies).

Initially, gastrointestinal complaints (resembling symptoms of appendicitis) are usually observed. Over time, symptoms may involve more organs, such as the kidneys, nervous system or circulatory system.

To correctly diagnose the disease, first of all, other possible viral and bacterial infections should be ruled out, and an appropriate test for COVID-19 (RT-PCR or antigenic) should be performed. It is also a good idea to test the next of kin and anyone who may have had any contact with the person diagnosed with the infection. [5]

PIMS – what tests?

Unfortunately, there is no specific test that can confirm or rule out PIMS. Laboratory tests such as:

● blood count;
● fibrinogen;
● d-dimers;
● inflammatory markers: ESR, CRP, procalcitonin, ferritin, lactate dehydrogenase;
● SARS-CoV-2 antibodies;
● sodium, potassium;
● triglycerides;
● amylase, lipase;
● creatinine, urea;
● AST, ALT, GGTP, bilirubin;
● albumin.

Treatment of PIMS

PIMS is a new disease entity that still requires appropriate testing and research. The mainstay of treatment is currently immunosuppressive and immunomodulatory therapy (i.e., intravenous infusions of immunoglobulin, glucocorticosteroids, and biologic drugs – infliximab, anakinra or tocilizumab). The goal of therapy is primarily to inhibit the uncontrolled development of the inflammatory response and prevent complications in the form of coronary artery aneurysms. Antithrombotic treatment is also often necessary.

Importantly, after PIMS, children should remain under medical supervision for at least six consecutive weeks.

Remember that suspected PIMS always requires hospitalization and constant medical supervision. In all children with suspected pocovid syndrome, a swab is taken for SARS-CoV-2 to rule out active infection.


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